22 April 2007

The triage nurse's note was not encouraging. Something to the effect of "85 year old male, fell, severe low back pain, unable to get out of chair x 3 days." These things are frequently nightmare cases -- either you have someone severely dehydrated and in kidney failure, septic, and terribly sick, probably moribund, or they are uninjured and well but you can't get them out of the ER due to pain, and nobody wants to admit them because there's no "medical indication" for admission and they don't want to deal with a case that medicare refuses payment on. Not the case one would choose to end the shift on, and didn't bode well for getting home on time.

Well, that's why I get paid the big bucks, right? I took a deep breath, squared my shoulders, and headed in. . .

The first thing that greeted me in the room was the strong odor of stale urine. Not a good sign. And the grizzled, unshaven face atop squalid clothing. Expectations met so far. But a pair of keen, bright eyes peered out at me from under bushy eyebrows and a big, albeit toothless, grin. He had been reading a book while waiting for me to come in! A book! After chatting with the fellow for a couple of minutes I determined he was a pleasant, extremely sharp fellow, neither terribly ill nor a complainer. He had never been ill a day in his life (a good recipe for living to 85, it must be said). After concluding the history, I went to examine him and gently picked up his book and put it aside, careful to mark his page with the bookmark. I forget the title of the book, but the bookmark was a large, glossy 4x8 photo which looked like this:"Nice plane," I commented."I used to fly it," he responded."What? Really? That exact one?""No, no, I flew a F model, that one's a G, but you couldn't really tell.""Wow. What did you do on it?""Pilot. 17 missions.""Damn."

It's hard to explain how he was transformed in my eyes after that. I so wanted to sit down with him and talk about his experiences. I am a pilot, and have nothing but awe for the guys who took off from England, flew these big beasts of aircraft, loaded with tens of thousands of pounds of bombs, across the Channel and over Germany with no navigational systems beyond a compass and a watch, dropped the bombs more or less on target, and returned home. Oh, yeah, and there were people shooting at them the whole time. They were real men.

I try to treat every patient with the same level of courtesy and compassion and all that humanistic bullshit, whether they are homeless scum or the wife of the hospital CEO, and I think I am pretty good at it. But it's pretty rare for me to really truly feel a sense of respect and indebtedness to a patient. In this case, it actually helped make the disposition easier. He turned out to have a couple of compression fractures in his lumbar spine, and despite pain medicine and his best effort, simply couldn't get up and walk. So I called up our hospitalist and began the conversation with: "Hi Jim, I have an interesting guy here. 85 years old with a couple of compression fractures in his back. He actually used to be a B-17 pilot in WWII.""No shit?" asked the hospitalist."Yeah, really. Anyway, he's in pain, so I'm admitting him to you.""Oh, of course. Send him up."

10 comments:

Consider the treatment of John Kerry and Max Cleland versus the treatment of John McCain and Bob Dole.

Consider the exploitation of Jessica Lynch and Pat Tillman.

Sometime between WWII and the Illegal Iraqi Invassion, liberals and conservatives switched sides on who was quick to go to war and who thought we should mind our own business. I'll give you that. But, I don't think liberals or conservatives have stopped holding up soldiers to be heroes.

Of course, the list from above demonstrates the difference in the way liberal politicians and conservative politicians treat veterans. But that is different from liberal and conservative citizens who all respect veterans.

You might meet more heroes and heroines if you took the time to be honest about the humanistic "shit" and took a real interest in the people. Good thing the poor fella had a signpost that you saw or else you had him pegged as worthless.

"You might meet more heroes and heroines if you took the time to be honest about the humanistic 'shit' and took a real interest in the people."

Wow. I got something very different from this post than most people. Shadowfax could hardly view every person he sees as a hero. And I don't think anyone who deals with the public--be they public school teachers, paramedics, or convience store workers--can avoid feeling generally frustrated with the crap they have to deal with.

I suppose Shadowfax could achieve some sort of enlightened salvation wherein he sees nothing but beauty in all things, but I suggest that it is pretty cool that in the meantime he goes around saving people's lives.

GREAT post. I have several such patients (heroes) in my road nurse company. They enthrall me with their WWII stories. I talk about them on the blog occasionally.

One guy had to bail out of his plane (with his co-pilot) because it was going to blow up after gunfire caused a fuel leak--- but he first had to turn the plane so that it would blow up over the Mediterranean instead of Prince Ranier's castle.

Another guy would tell me stories of being his plane being flung off those old aircraft carriers with catapults. I asked him if he ever got shot up on his missions and he said: "Yeah, but I always brought my plane home."

Another guy said he and some of his buddies crashed all their planes right after take-off one morning because the enemy had sabotaged their planes in the night.

Another guy said he endured nightmares all his life about almost being stuck with an enemy soldier's bayonet in a foxhole (but his life was saved by his buddies at the last minute). He died recently after fracturing two hips in a fall, and I'm glad his nightmares are over now.

Another old guy can't talk about the war because he always starts crying.

All these guys have lingering joint/back/burn injuries/scars from their experiences but never complain. Their relatives usually have to tell me or I'd never hear a peep out of them.

N=1 -- I guess you missed the bit where I pointed out that I *treat* everyone well. But I see a LOT of people, and just don't have the time or interest to make a personal connection with all of them. I've got to move the meat. As much as I might like or hate a given patient, it is irrelevant because I have to move the meat. Yeah, "meat" is a dehumanizing and highly impersonal way to refer to our patients, isn't it? Get over it. I have a job to do, and I do it with a high degree of technical skill and interpersonal quality. People feel as if I care about them, not because I do, but because making people feel like I care is part of the job. I don't have the emotional energy to care about 2-3 people per hour, 10 hours at a go, 15 days a month. And anyone who says they do is full of it. But I fake it and fake it well, and people like me for it (I say without pride, just a fact). And every once in a while someone comes along who is truly exceptional in a way that is apparent in the seventeen minutes I have for them, and that's pretty cool.

And I won't apologize for feeling little to nothing for the rest. My job is to take care of them, not to be their friend. They go home better and feeling like their physician listened and cared. Mission accomplished.

"Consider the treatment of John Kerry and Max Cleland versus the treatment of John McCain and Bob Dole."

haha.

imagine for a second, john mccain as a democrat.

nobody in this country that watches cable tv news or listens to talk radio would have an ounce of hearing left, due to the high pitched squeals that would have been emitted non-stop from the right over the course of his political career regarding his, err, 'confession' while he was held prisoner in hanoi.

I'm a pilot, too, and was taught by two WWII pilots, and am grateful for every moment of listening to them talk about their experiences. Hard to believe many people today are so ignorant they are unable to appreciate what the WWII U.S. military accomplished.

Well Said... I think sometimes that I became an EMT and that I am now going into emergency medicine because seeing some of the tragedy forces me to realize (again) that my life is pretty good. Still, after you see enough tragedy even that seems to not snap you out of the self-pity at times. I can appreciate the meaning behind seeing a patient like this. When you think of what he lived through every time the tires left the tarmac you realize, again, we have it pretty good.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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